Search

Hospital researchers from Lawson Health Research Institute have published a recent study that assessed the use of a specialized treatment for chronic pain and its impact on health care use and opioid prescribing.   

Paravertebral blocks (PVBs) belong to a broader group of procedures called “nerve blocks.” A recent Toronto Star report noted that OHIP has been billed $420 million for nerve block procedures since 2011. PVBs involve injecting medication around the nerves where they exit the bones of the spine, at different locations depending on the patient and the chronic pain they are experiencing.  

The regular use of these procedures has been questioned by health care providers due to the high cost and limited evidence of their benefit in reducing chronic pain. While the effectiveness of PVBs has been examined in trauma, cancer pain and regional anesthesia during surgery, they have not been evaluated for use in chronic pain despite widespread use in Ontario.  

It is estimated that one in five Canadians live with chronic pain. Pain that persists can affect all aspects of someone’s life and health, particularly when it is not being managed.  

“Frequent use of PVB is common. Initiating treatment with PVCs is associated with marked increases in health care utilization, which includes physician visits and other injection procedures,” explains Dr. Eldon Loh, Lawson Associate Scientist and Physiatrist at St. Joseph’s Health Care London. 

This research provides a broad perspective on the use of PVBs in Ontario, and on the use of nerve blocking treatments in general. There has been a concern for several years about the over use of these procedures; however, this is the first study to systematically document the impact on health care utilization and opioid use. 

"We hope that from this study, the appropriate use of PVBs and other pain interventions will be re-evaluated at a provincial level to ensure the use of health resources is being properly managed and we achieve the best outcome for patients,” Dr. Loh adds. 

From falls prevention to depression therapies, scientists at Lawson Health Research Institute are conducting important mental health studies. Held on Thursday, September 15, the 17^th Annual Mental Health Research Half Day at the Parkwood Institute Mental Health Program was a chance to share and celebrate this research.

The Mental Health Research Half Day featured poster and oral presentations, as well as the 12^th Annual Tony Cerenzia Research Lecture. Clinical, administrative and research staff attended to learn more about research happening at Parkwood Institute and the Southwest Centre for Forensic Mental Health Care, part of the St. Joseph’s Health Care London family.

“The Mental Health Research Half Day provides an opportunity for researchers at Parkwood Institute and the Southwest Centre for Forensic Mental Health Care to present their research findings to clinical and administrative staff,” said Dr. Richard O’Reilly, Director of Psychiatric Research at Parkwood Institute & Southwest Centre and a Scientist at Lawson. “It is important that all clinical staff, who may not be directly involved in research, know what studies are being conducted and their impact on patient care.”

The 12^th Annual Tony Cerenzia Research Lecture was delivered by Dr. Nathan Herrmann, Associate Scientist, Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute and Head of the Division of Geriatric Psychiatry at Sunnybrook Health Sciences Centre. Dr. Herrmann delivered an engaging lecture titled “Managing Neuropsychiatric Symptoms in Dementia: An Evidence-Based Approach”.

Attendees were engaged not only by this highly informative lecture but also by the poster and oral presentations which covered a broad range of research topics. Presenters were also enthusiastic about  the day and the opportunities it provided.

“The Mental Health Research Half Day is a great event which provides networking opportunities here at Parkwood Institute. It allows staff from across St. Joseph’s to learn about different research happening across program areas,” said Erin Finley, an Occupational Therapist (OT) in Geriatric Psychology at Parkwood Institute.

Finley and her colleagues were one of seven poster presentations. Their research project, titled “Fall prevention initiative in geriatric psychiatry”, aimed to reduce the rate of falls with injury among patients with dementia in a behavioural health unit. Within an 18-bed unit, they were able to significantly reduce falls with injury with zero incidences in the last two months of their data collection period.

Researchers at Lawson Health Research Institute (Lawson) are developing a hand-held photoacoustic imaging probe to be used during breast conserving surgery to quickly and accurately verify if all cancerous tissue has been removed.

Surgeons currently do not have real-time technology to guide tumour removal during surgery.

Using current tools, there is a 20 per cent chance that cancerous cells will be left behind, risking recurrence and repeat surgery.

Breast cancer represents 25 per cent of all new cancer diagnoses in women and 13 per cent of all cancer related deaths in women. Treatment for breast cancer often requires either complete breast removal in severe cases, or surgical removal of the cancerous tumour in combination with other therapies. Removing only the tumour is called breast conserving surgery.

Image

Photoacoustic Screening

The new device is an extension of the photoacoustic screening (iPAS) technology developed in the laboratory of Dr. Jeffrey Carson, Principal Investigator and Lawson Scientist. The technique uses light and sound to capture 3D images of surgically removed breast tissue. Their studies show that iPAS can catch up to 75 per cent of missed tumour cells, decreasing the odds of failed surgery to five per cent.

Dr. Muriel Brackstone, Associate Scientist at Lawson, Head of the Breast Care Clinic at St. Joseph’s Hospital London, and Surgical Oncologist at London Health Sciences Centre, brings her clinical expertise to the project.

“With the first generation iPAS technology, we would remove the tumour, take it to the lab for imaging and wait to see if there was a rim of normal tissue around the removed tumour so we knew it was removed completely. The wait was anywhere from 20 minutes to an hour. During that time, the patient is under anesthesia, the surgical team is idle and precious OR time is being used,” explains Dr. Brackstone.

A hand-held tool that surgeons can use

Creation of a hand-held probe to be used in the operating room is the next step in the advancement of this new technology. Elina Rascevska, biomedical engineering student at Western University, recently joined the Lawson team to convert lab-based iPAS technology into a hand-held device.

“We have developed a prototype of the iPAS probe, and once we can verify the quality of the images it produces, we will give it to Dr. Brackstone to test in the OR,” says Rascevska.

The iPAS probe does not need a trained operator and would be used by the surgical team. Instead of imaging the removed tissue, it scans the surgical cavity in real time to give the team a faster and more accurate indication as to whether the cancerous tissue has been removed.

“If we can progress this technology to a point where physicians can use it as part of standard protocols, we will have reduced the amount of time each patient needs to spend in the OR, the amount of call-backs and repeat surgeries, and ultimately improve quality of life for patients with breast cancer,” adds Dr. Carson.

Image

Post-traumatic stress disorder (PTSD) is a condition that often develops in those who have experienced a traumatic event. PTSD affects close to 10 per cent of Canadians, and in some cases, can be difficult to treat. 

In a new study through Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry, scientists are looking at a form of treatment called deep brain reorienting (DBR) for those suffering from PTSD.

“In our study we are looking at ways of trauma processing at the foundation of the stress response,” explains Dr. Ruth Lanius, Associate Scientist at Lawson and Professor at Western’s Schulich School of Medicine & Dentistry. “When you are faced with a stressor the first thing you do is turn your attention to it, and when you do that you engage your head and neck muscles.”

Image

DBR was developed by Scottish psychiatrist Dr. Frank Corrigan and focuses on the muscles of the shoulders, neck, head and face of patients when recalling a traumatic event. This form of trauma processing starts right at the moment the stressor is noticed by the individual, which is often quickly followed by a moment of shock.  By addressing the stressor at this level, doctors can target the foundation of where the stress response begins.

“When patients bring up a trigger in their mind, we look at what happens in terms of the tension in their head and neck.  We process that gently by asking the patient to notice and stay with that tension without trying to release it, and over time the tension usually decreases,” explains Dr. Lanius, who is also a Psychiatrist at London Health Sciences Centre. “The second part involves addressing the shock response. You turn your attention to the stressor and then notice any moments of shock that follows, which is often associated with tension behind the eyes and in the shoulders. Finally, you address the visceral sensations associated with feelings and emotions associated with the stressor.”

Dr. Lanius believes that by using DBR and focusing on muscle and visceral responses, it will help patients suffering from PTSD to process the visceral feelings associated with the trauma and its triggers.

Image

“After this form of treatment, patients often say they feel safer and don’t see themselves negatively, like they did in the past,” says Dr. Lanius. “This is because we change those intense visceral feelings and it allows the person to reevaluate who they are and how they interact with the world.”

The research team is hoping to recruit approximately 60 people to take part in the DBR study.  Participants will undergo a psychological interview and an MRI, then eight sessions of treatments. Following those sessions, participants will have another interview and MRI to assess if any positive changes were made within the neurological networks and/or in psychological systems.

“Our hopes are to really personalize treatment for those living with PTSD,” says Dr. Lanius. “Some people have difficulty tolerating some forms of trauma processing and in my experience this treatment is a gentler approach for those individuals.”

Interested participants who have been diagnosed with PTSD can contact Suzy Southwell, Research Coordinator, at 519-685-8500 ext. 35186 or @email.

The unique and challenging experiences faced by Canadian Armed Forces (CAF) Veterans puts this group at high risk for developing symptoms of mental health disorders, such as Post traumatic stress disorder (PTSD), depression, and anxiety. Researchers at Lawson Health Research Institute (Lawson) have been awarded over $40,000 from Veterans Affairs Canada to study various risk and protective factors associated with mental health disorders in CAF Veterans.  

The study aims to learn whether an individual’s personality traits serve as risk or protective factors for Veterans developing mental health problems. The traits that will be examined include openness, agreeableness, emotionality, honesty-humility, conscientiousness, extraversion, and resiliency. For example, someone who is high in openness and resiliency may have a lower risk of developing mental health symptoms.  

“Veterans and military members experience uniquely challenging events when compared to the general population,” explains Dr. Rachel Plouffe, study co-lead and Postdoctoral Associate at Lawson. “Past research has identified some risk factors, including history of childhood trauma, age, gender, and education. However, no one to date has investigated the role that personality traits might play in Veterans’ symptoms of mental health conditions.” 

The research team will look at the relationship between these personality traits, exposure to stressful experiences during military operations, and mental health outcomes through survey data provided by 500 treatment-seeking and non-treatment seeking Veterans. This information will be used to assess whether the individual’s expression of these personality traits can predict levels of depression, anxiety and PTSD.  

They also hope to determine whether the association between combat exposure and PTSD is stronger for those higher in traits such as emotionality, which reflects those who tend to be anxious and fearful. On the other hand, this association will likely be weaker for those higher in more “positive” traits, such as agreeableness, as these individuals tend to be cooperative and forgiving toward others.  

Plouffe notes that personalities are not completely stagnant. Certain traits can often change over time, and individuals can work to increase their levels of resiliency.  

“Ultimately, our hope is to help improve the ability of CAF members and Veterans to thrive even in the face of great adversity. With the findings from our research, military organizations and mental health treatment centres could use the information from this study to predict which patients may be at greater risk of developing mental health disorders, and provide tailored treatment for these individuals,” she explains.  

“This research is needed for military organizations to improve and implement strategies that enhance the well-being of Veterans and active service members,” says Dr. Don Richardson, study co-lead and Director of the MacDonald Franklin OSI Research Centre at Lawson. “Our Veterans give a lot to serve and protect, so it is our duty as researchers and clinicians to find ways that we can better serve them.”

Researchers from Lawson Health Research Institute and the Centre of Excellence on PTSD and Related Mental Health Conditions are seeking 500 Canadian health care workers to participate in a study on moral distress and psychological wellbeing during the COVID-19 pandemic. Participants will complete online surveys once every three months for a total of 18 months. The goal is to better understand the pandemic’s impact on health care workers in order to minimize moral distress and support wellbeing during future pandemic events.  

Moral distress is a form of psychological distress that occurs following an event that conflicts with a person’s moral values or standards. Through previous research with military populations, moral distress has been linked to an increased risk of post-traumatic stress disorder (PTSD) and depression.

“Health care workers are facing unprecedented demands as a result of the pandemic and many may be working under extreme physical and psychological stress,” says Dr. Don Richardson, Lawson Associate Scientist and Director of the MacDonald Franklin Operational Stress Injury (OSI) Research Centre. “Health care workers may face difficult moral-ethical decisions including those around patient care and shortages of personal protective equipment (PPE), which could lead to moral distress.”

The study will consist of a series of surveys to assess moral distress during the pandemic. Participating health care workers will answer questions about moral-ethical dilemmas and symptoms of depression, PTSD, general anxiety, and burnout. 

“Moral-ethical dilemmas must be considered in the context of other difficulties faced by health care workers during the pandemic, such as increased workloads, reduced social activities, and evolving work environments and health care delivery models,” explains Dr. Anthony Nazarov, Associate Scientist at Lawson and the MacDonald Franklin OSI Research Centre. 

The team hopes that results can be used to cultivate wellness at the outset of future pandemics. This might include guiding emergency preparedness policies and moral-ethical decision-making training modules. They hope that by tracking psychological outcomes over time, they can identify early warning signs of distress that can be targeted with early interventions. 

The researchers will also ask questions that explore how the pandemic is impacting health care delivery, such as increased reliance on virtual care appointments, and whether health care workers are satisfied with these changes. 

“It is necessary to provide a voice to health care workers during this pandemic,” adds Dr. Richardson. “This is the first study to measure the moral-ethical dilemmas faced in a pandemic and the impacts of such dilemmas on moral distress. It is also the first to measure health care worker perceptions on the virtual migration of patient care.”

Researchers at Lawson Health Research Institute are the first in the world conducting a clinical trial to test a triple intervention aimed at treating Mild Cognitive Impairment (MCI) and delaying the onset of dementia. The Mobility, Exercise and Cognition (MEC) team will be incorporating physical exercises, cognitive training and vitamin D supplementation to determine the best treatment for improving mobility and cognition.

“We have learned the brain processes involved in motor-control - for example how a person walks - and cognition - for example how that person solves a problem - share similar locations and networks in the brain,” explains Dr. Manuel Montero Odasso, Lawson Scientist and Geriatrician at St. Joseph’s Health Care London. “Problems with mobility are connected to lowering function in the mind, and so can be a good indicator of future progression into dementia.”

Dr. Montero Odasso is also an Associate Professor in the departments of Medicine and Epidemiology and Biostatistics at the Schulich School of Medicine & Dentistry, Western University. 

Image

MCI is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It can involve problems with memory, language, thinking and judgment. While many older individuals experience decline in both mobility and cognition, each are assessed and treated separately with no specific recommendations available for physicians.

The SYNERGIC Trial will combine physical exercises, cognitive training and vitamin D to test how these interventions work together to improve cognition in older adults at risk for dementia. The trial is targeting cognitive decline at the earliest stage, individuals with MCI, where interventions are more likely to have an effect and can be monitored.

Image

Dr. Montero Odasso explains that both physical and cognitive exercises have shown promising effects for maintaining cognition, while vitamin D deficiency is associated with cognitive decline. A key feature of this trial is that participants will receive individualized and progressive training.

“By delaying declines in cognition, we can improve a person’s quality of life. This research will help to support a more comprehensive preventative treatment with clinical guidelines for physicians whose patients are at risk of developing dementia,” states Dr. Montero Odasso. “Even more, each one year delay of progression to dementia in older individuals at risk has the opportunity to save billions of dollars for the Canadian health care system.”

Individuals over 60 years old with mild cognitive impairment without dementia are eligible for this clinical trial. Those interested in participating are encouraged to contact Research Coordinator Alanna Black at 519.685.4292 ext. 42179.

Participants will be asked to complete a routine of exercises and cognitive training three times a week for six months, with one final assessment at 12 months. The main site for the study is Parkwood Institute with physical exercises taking place at the Labatt Health Sciences Building at Western University, in Dr. Kevin Shoemaker’s Laboratory for Brain and Heart Health.

This study has been funded by the Canadian Consortium on Neurodegenerative in Aging (CCNA) which represents Canada-wide research aimed at enhancing the quality of life and services for individuals diagnosed with a neurodegenerative disease. The MEC team in London, led by Dr. Montero Odasso, includes expert researchers in the field of mobility who aim to develop common assessments for the interaction of cognition and mobility for older people to aid as a diagnostic tool for detecting dementia. 

Image

A team from Lawson Health Research Institute are being funded by the Government of Ontario’s COVID-19 Rapid Research Fund to study whether inhaled sedatives can replace those that are delivered intravenously in COVID-19 patients requiring ventilation. The multi-centre clinical trial aims to address a global shortage of intravenous (IV) sedatives while improving patient outcomes. 

“When COVID-19 patients develop severe respiratory failure and need to be ventilated, they require sedation. While IV sedatives are currently used, there is concern about global drug shortages, particularly if there’s a second wave of COVID-19 in the fall,” explains Dr. Marat Slessarev, Scientist at Lawson and Critical Care Physician at London Health Sciences Centre (LHSC). “Even if we have enough ventilators, we won’t be able to ventilate patients without sedatives.”

The clinical trial, being co-led by Dr. Slessarev and Dr. Angela Jerath at Sunnybrook Health Sciences Centre, will study the replacement of IV sedatives with inhaled sedatives. Inhaled sedatives, also called volatiles, are widely available due to their use in operating rooms to sedate patients during surgery. While they have not been routinely used to sedate patients needing ventilation, early studies suggest they could be safe and even more effective than IV sedatives. 

“Preliminary studies in non-COVID patients with severe respiratory failure suggest that inhaled sedatives can reduce lung inflammation, shorten the duration of ventilation and potentially improve survival. Inhaled sedatives could therefore reduce the pandemic’s strain on ventilator capacity while improving patient outcomes,” says Dr. Slessarev. “Since these drugs are safe, cheap and readily available, they can easily be used to address IV sedative shortages if found effective.”

The researchers will recruit approximately 800 patients from across Canada and the United States including patients from LHSC. Each patient will be randomized to receive either IV sedatives or inhaled sedatives. Patient outcomes such as survival and length of ventilation will be compared between the two groups to determine which method of sedation is most effective. 

“This is the largest trial of its kind. If inhaled sedatives can shorten the length of ventilation or improve survival in patients with serve respiratory failure, this could cause a paradigm shift in the way we sedate patients in intensive care units (ICUs) around the world,” notes Dr. Slessarev. 

Given many survivors of critical illness experience cognitive impairment for months or even years after an intensive care unit (ICU) stay, the team is also planning a sub-study to assess whether one method of sedation results in better cognitive outcomes after treatment. 

In addition to funding from the Government of Ontario, the study is being supported with funding from the Canadian Institutes of Health Research (CIHR), London Health Sciences Foundation and Sunnybrook Health Sciences Centre.

Image

Dr. Marat Slessarev, Scientist at Lawson and Critical Care Physician at LHSC

As we continue to live with a COVID-19 pandemic, patients will need good treatment options.

Hospital researchers in London, Ontario, through Lawson Health Research Institute, are testing treatment options for patients who have been hospitalized from a COVID-19 infection, often for severe symptoms.

During the peaks of the COVID-19 pandemic, there were concerns of a global drug shortage when it came to IV sedatives for patients needing ventilation. Through funding from the Government of Ontario’s COVID-19 Rapid Research Fund, a team of Ontario researchers studied whether inhaled sedatives could replace those that are delivered through IV.

“In addition to easing the burden on IV stocks, the inhaled sedatives have additional benefits,” says Dr. Marat Slessarev, a Critical Care Physician at LHSC. “They may reduce inflammation in the lungs and shorten the duration of sedation because they are eliminated from the body faster than IV sedatives.”

Dr. Slessarev, also a Scientist at Lawson, adds that using inhaled sedatives could also be safer for severe COVID-19 patients, who in many cases are on a ventilator for a long time. “When using IV sedatives, they can accumulate and metabolize with accumulation. This can leave the patient with the potential of developing kidney issues because it is hard to dispel them quickly.” 

Image

Dr. Marat Slessarev, Critical Care Physican at LHSC and Lawson Scientist

To date, around 800 patients across ten hospital sites have been enrolled in this trial, with the hopes of getting more hospital sites on board as the clinical trials continue.

• Read more about this multi-centre clinical trial.

A majority of people with severe COVID-19 infections in critical care end up developing sepsis, which is a potentially life-threatening condition that occurs when the body's response to an infection damages its own tissues. 

“An inflammatory response is what the body uses to fight an infection, but sometimes it is more than necessary and it causes damage to the organs and the body,” explains Dr. Claudio Martin, a Physician in the Intensive Care Unit (ICU) at London Health Sciences Centre (LHSC). “This is why a patient with a severe COVID-19 infection caused by a virus can get sepsis.”

Dr. Martin, who is also an Associate Scientist at Lawson, began studying the use of a human protein called Annexin A5 as a potential treatment for COVID-19 patients with sepsis. “It can work in two ways. The annexin may coat injured cells and reduce the inflammatory response. Or, the injured cells and exposed proteins trigger the clotting mechanism in the body. Those with COVID-19 could get blood clots in the brain and the lungs, and using annexin may improve their outcomes.”

Image

Dr. Claudio Martin, Critical Care Physician at LHSC and Lawson Scientist

Currently, a clinical trial using Annexin A5 on severe COVID-19 patients is underway at LHSC to look at the efficacy of using this human protein.

• Read more about this clinical trial.
   

The COVID-19 virus is also known to cause respiratory failure, prompting Dr. Jim Lewis, Respirologist at St. Joseph’s Health Care London and Scientist at Lawson, to investigate the use of pulmonary surfactant as a potential treatment for these patients.

Bovine Lipid Extract Surfactant Suspension (BLES) is a pulmonary surfactant manufactured in London, Ontario. It’s currently used worldwide to help improve lung function in premature babies. Now, it is being studied with COVID-19 patients experiencing respiratory failure.

Image

Dr. Jim Lewis, Repirologist at St. Joseph's Health Care London and Lawson Scientist 

“We know that patients who have injury to their lung and require ventilation have inflammation in the airways of their lungs. Surfactant is a homogeneous layer of lipids and proteins that line the lungs to allow us to breath with minimal effort,” explains Dr. Lewis. “If we gave these patients surfactant as soon as possible after they were put on a mechanical ventilator, it may have some benefit in improving their outcome and getting them off the ventilator sooner.”

Dr. Lewis and his team conducted a clinical trial using pulmonary surfactant with ten critically ill COVID-19 patients and initial results have shown patient safety and efficacy.

• Read more about the BLES study.
   

Another team of hospital researchers turned to using modified dialysis machines to offer treatment options to those with severe COVID-19 symptoms. Nephrologist at LHSC, Dr. Chris McIntyre, was the first in the world to modify a dialysis device to treat a patient with COVID-19.  The device gently removes a patient’s blood, modifies white blood cells, and returns them to fight hyperinflammation.

Image

Dr. Chris McIntyre, Nephrologist at LHSC and Lawson Scientist

“It was quick.  We went from the initial idea to the approvals, creating the device and appointing the first patient within 40 days,” says Dr. McIntyre who is also a Scientist at Lawson. “After the first 12 patients, we found that those treated with the device needed significantly less drugs to maintain their blood pressure. We were able to deliver the treatment for all the patients – none of the treatments failed and we had no safety issues.”

Dr. McIntyre is now looking into using this form of therapy for chronic dialysis patients to help modify organ injury.

• Read more about his COVID-19 research with modified dialysis machines.